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- Rehabilitation Measures Database
- Utrecht Scale for Evaluation of Rehabilitation-Participation
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Purpose
This questionnaire is about the patient’s daily life and consists of four parts: (1A) how much time you spend working, studying and attending to household duties, (1B) how often you undertake certain activities, (2) whether you experience any limitations in your daily life and (3) how satisfied you are with your daily life.
Link to Instrument
Acronym USER-Participation
Area of Assessment
Patient Satisfaction
Functional Mobility
Occupational Performance
Life Participation
Quality of Life
General Health
Social Relationships
Assessment Type
Patient Reported Outcomes
Cost
Free
Actual Cost
$0.00
Populations
Stroke
Spinal Injuries
Non-Specific Patient Population
Mixed Populations
Key Descriptions
- 31 items
- 3 scales (Frequency, Restrictions, Satisfaction)
Equipment Required
- Paper and pen/pencil
Time to Administer
25-35 minutesminutes
Required Training
No Training
Instrument Reviewers
Instrument reviewed by MaryEllen Targonski, Emily Vosburg, John Justyn, Natalie McNerney, Mikela Nylander-French, Mohammed Chehata. Duke University in 2019.
Updated by Zayd Hayani in 2020.
ICF Domain
Body Function
Activity
Participation
Measurement Domain
Emotion
General Health
Considerations
Make sure to explain to the patient that this questionnaire is about normal daily life, and holidays and special occasions should not be taken into account.
Spinal Injuries
back to PopulationsNormative Data
Spinal Cord Injury: (Mader et al, 2016, n=1,549; mean age=52.4(14.8); time post injury in years=16.9 (12.7); Severity: 41.7% complete SCI, 57.7% incomplete SCI)
- Score distributions of USER-Participation
n | Mean (SD) | Median (IQR) | |
Frequency | 1,474 | 34.2 (12.2) | 34.3 (26.1-42.5) |
Restrictions | 1,491 | 70.0 (21.7) | 72.7 (54.5-87.9) |
Satisfaction | 1,459 | 69.3 (18.0) | 72.5 (58.3-80.6) |
Spinal Cord Injury: (van der Zee et al, 2014; n=157; mean age=50.6 ±10.5; time post injury in years=25.3 ±26.8; Severity: 69.4% complete SCI, 30.6% incomplete SCI)
- Score distributions of USER-Participation
n | Mean (SD) | Median (IQR) | |
Frequency | 157 | 34.8 (10.0) | 36.1 (29.1-41.4) |
Restrictions | 157 | 72.6 (19.3) | 75.8 (60.3-87.9) |
Satisfaction | 156 | 69.9 (14.3) | 72.2 (60.0-79.5) |
Internal Consistency
Normative Sample: (Mader et al, 2016, n=1,549; mean age=52.4(14.8); time post injury in years=16.9 (12.7); Severity: 41.7% complete SCI, 57.7% incomplete SCI)
- Excellent: Restrictions and Satisfaction scale (Cronbach’s alpha=0.9)
- Poor: Frequency scale (Cronbach’s alpha=0.65)
Normative Sample: ( van der Zee et al, 2014; n=157; mean age=50.6 ±10.5; time post injury in years=25.3 ±26.8; Severity: 69.4% complete SCI, 30.6% incomplete SCI)
- Excellent: Restrictions scale (Cronbach’s alpha=0.89)
- Adequate: Satisfaction scale (Cronbach’s alpha=0.78)
- Poor: Frequency scale (Cronbach’s alpha=.51)
Criterion Validity (Predictive/Concurrent)
Concurrent Validity:
Spinal Cord Injury: ( van der Zee et al, 2014; n=157; mean age=50.6 10.5; time post injury in years=25.3±26.8; Severity: 69.4% complete SCI, 30.6% incomplete SCI)
- Concurrent validity between the three scales was demonstrated with a Spearman correlation coefficient below 0.60 for all 3 scales
- 0.39 between frequency and restriction scales
- 0.40 between frequency and satisfaction scales
- 0.46 between restriction and satisfaction scales
Construct Validity
Discriminant Validity:
Spinal Cord Injury: (van der Zee et al, 2014; n=157; mean age=50.6 10.5; time post injury in years=25.3 ±26.8; Severity: 69.4% complete SCI, 30.6% incomplete SCI)
- Significant (P<0.05) discriminant validity between paraplegia and tetraplegia was shown for all 3 scales using Mann-Whitney U Test scores (z):
- Frequency: z=-2.29
- Restrictions: z=-3.17
- Satisfaction: z=-1.99
Content Validity
The content validity of the USER-Participation may be affected by excluding domains related to work-related participation. “The anchor method was applied to appropriately account for items within the USER-Participation Restrictions and Satisfaction scales that are not applicable to some of the participants” (Mader et al, 2016).
Floor/Ceiling Effects
Spinal Cord Injury: (Mader et al, 2016, n=1,549; mean age=52.4(14.8); time post injury in years=16.9 (12.7); Severity: 41.7% complete SCI, 57.7% incomplete SCI)
- Excellent: Floor effects ranging from 0.0-0.3%
- Excellent: No ceiling effect for Frequency scale (0.0%)
- Adequate: Ceiling effect for Satisfaction (3.0%) and Restriction (9.5%) scales
Spinal Cord Injury: (van der Zee et al, 2014; n=157; mean age=50.6 10.5; time post injury in years=25.3 ±26.8; Severity: 69.4% complete SCI, 30.6% incomplete SCI)
- Excellent: No floor of ceiling effects for any scales
Stroke
back to PopulationsTest/Retest Reliability
Stroke: (Groeneveld, 2019; n=373, Mean age= 58.85 (12.3), Mean time between stroke and start of rehabilitation= 31 days (16))
- Satisfactory test-retest reliability (ICC=. 65-.85)
Internal Consistency
Stroke: (Groeneveld, 2019; n=373, Mean age= 58.85 (12.3), Mean time between stroke and start of rehabilitation= 31 days (16))
- Satisfactory internal consistency (Cronbach’s alphas .7-.91)
Non-Specific Patient Population
back to PopulationsInternal Consistency
Rehabilitation Outpatients: (Post MWMet al., 2012; n = 395, Dutch sample)
- Satisfactory: Cronbach's alpha range from 0.70–0.91
Construct Validity
Convergent Validity:
Rehabilitation Outpatients: (Post MWMet al., 2012; n = 395, mean age = 52.8(SD =13.5 years), Dutch Sample)
| USER-P Frequency | USER-P Restrictions | USER-P Satisfaction | |
|---|---|---|---|
| Frenchay Activities Index (FAI) | 0.59 | 0.51 | 0.42 |
ICF Measure of Participation and Activities Screener (IMPACT-SP) | 0.48 | 0.75 | 0.64 |
| Participation Scale | −0.40 | −0.71 | −0.73 |
Discriminant Validity:
Rehabilitation Outpatients: (Post MWMet al., 2012; n = 395, mean age = 52.8(SD =13.5 years), Dutch Sample)
USER-Participation scores differed between participants with different functional ability and between participants with different health conditions
| Frequency | Restrictions | Satisfaction | |
|---|---|---|---|
| Diagnosis | |||
| Musculoskeletal (n = 69) | 27.5 | 73.3 | 69.4 |
| Brain injury (n = 138) | 26.3 | 80.9 | 72.2 |
| Neurological (n = 87) | 28.7 | 66.7 | 66.7 |
| Heart condition (n = 39) | 32.5 | 100 | 80.6 |
| Chronic pain (n = 58) | 28.7 | 71.9 | 64.8 |
| Kruskal–Wallis Chi-square | 8.91 | 57.62 | 22.72 |
| p value | 0.063 | < 0.001 | < 0.001 |
| Physical independence | |||
| Low (≤ 65) (n = 198) | 26.3 | 70 | 63.9 |
| High (66–70) (n = 191) | 31.3 | 88.2 | 77.8 |
| Mann–Whitney Z | −6.34 | −10.63 | −7.27 |
| p value | < 0.001 | < 0.001 | < 0.001 |
| Cognitive independence | |||
| Low (≤ 48) (n = 205) | 25 | 71.8 | 63,9 |
| High (49–50) (n = 184) | 30 | 83.3 | 77.8 |
| Mann–Whitney Z | −3.74 | −4.35 | −6.58 |
| p value | < 0.001 | < 0.001 | < 0.001 |
Floor/Ceiling Effects
Rehabilitation Outpatients: (Post MWMet al., 2012; n = 395, mean age = 52.8(SD =13.5 years), Dutch Sample)
- No floor effects were found and only the Restrictions scale showed a ceiling effect of 19.0.
Mixed Populations
back to PopulationsNormative Data
Brain Injury or Neuromuscular Disease
t1 | t2 | t3 | |||||||
n | Mean (SD) | Skewness | n | Mean (SD) | Skewness | n | Mean (SD) | Skewness | |
USER-Participation (0 – 100): | |||||||||
Frequency | 47 | 32.0 (10.6) | 0.119 | 47 | 31.3 (9.3) | –0.390 | 37 | 31.3 (10.0) | –0.215 |
Restrictions | 47 | 65.9 (20.8) | –0.328 | 45 | 69.5 (22.4) | –0.343 | 36 | 71.3 (19.6) | –0.762 |
Satisfaction | 45 | 61.1 (16.5) | –0.287 | 47 | 66.5 (18.8) | –0.110 | 37 | 67.2 (19.6) | –0.045 |
van der Zee, 2013; nT1=47, nT3 = 37; mean ageT1 = 53.0(12.9), mean ageT3= 53.4(14.0); time post injury not reported
Internal Consistency
Brain Injury or Neuromuscular Disease van der Zee, 2013; nT1=47, nT3 = 37; mean ageT1 = 53.0(12.9), mean ageT3= 53.4(14.0); time post injury not reported
- Satisfactory internal consistency: 0.65 for the Frequency scale to 0.85 for the Restriction scale
Criterion Validity (Predictive/Concurrent)
Brain Injury or Neuromuscular Disease
van der Zee, 2013; nT1=47, nT3 = 37; mean ageT1 = 53.0(12.9), mean ageT3= 53.4(14.0); time post injury not reported
- Good concurrent validity was demonstrated by Spearman’s correlation coefficient (r = 0.59 to 0.75).
Concurrent validity between the IPA and the USER-Participation at t2 (Pearson's r).
| IPA | ||||||
| Autonomy indoors | Family role | Autonomy outdoors | Social life & relationships | Work & education | ||
| USER-Participation | Frequency | –0.43** | –0.62** | –0.50** | –0.34* | –0.43* |
| Restrictions | –0.56** | –0.71** | –0.65** | –0.40** | –0.45* | |
| Satisfaction | –0.64** | –0.71** | –0.81** | –0.78** | –0.68** |
Floor/Ceiling Effects
Brain Injury or Neuromuscular Disease
van der Zee, 2013; nT1=47, nT3 = 37; mean ageT1 = 53.0(12.9), mean ageT3= 53.4(14.0); time post injury not reported
Floor and ceiling effects were considered present if 15% or more of respondents scored respectively the worst possible or best possible score on a scale.
- Small ceiling effect: The USER-Participation Restriction scale showed a ceiling effect at t2 (15.5%)
Responsiveness
Brain Injury or Neuromuscular Disease
van der Zee, 2013; nT1=47, nT3 = 37; mean ageT1 = 53.0(12.9), mean ageT3= 53.4(14.0); time post injury not reported
Moderately responsive with the standardized response mean ranging from 0.2 for the Frequency scale to 0.5 for the Restriction scale
Responsiveness of the USER-Participation scales between t1 and t2 and between t1 and t3.
t1–t2 | t1–t3 | |||||||
n | Mean difference (SD) | ES | SRM | n | Mean difference (SD) | ES | SRM | |
Frequency | 47 | –0.7 (10.5) | –0.07 | –0.07 | 37 | –2.4 (11.4) | –0.23 | –0.21 |
Restrictions | 45 | 3.8 (17.6) | 0.18 | 0.21 | 36 | 5.4 (17.2) | 0.27 | 0.31 |
Satisfaction | 45 | 5.7 (17.5)* | 0.34 | 0.32 | 36 | 4.0 (17.0) | 0.26 | 0.24 |
Bibliography
Mader L, Post MWM, Ballert CS, Michel G, Stucki G, Brinkhof MWG. Metric properties of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) in persons with spinal cord injury living in Switzerland. J Rehabil Med. 2016;48(2):165-174. doi:10.2340/16501977-2010.
van der Zee CH, Post MW, Brinkhof MW, Wagenaar RC. Comparison of the Utrecht Scale for Evaluation of Rehabilitation-Participation With the ICF Measure of Participation and Activities Screener and the WHO Disability Assessment Schedule II in Persons With Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation. 2014;95(1):87-93. doi:10.1016/j.apmr.2013.08.236.
Groeneveld IF, Goossens PH, van Meijeren-Pont W, et al. Value-Based Stroke Rehabilitation: Feasibility and Results of Patient-Reported Outcome Measures in the First Year After Stroke. Journal of Stroke and Cerebrovascular Diseases. 2019;28(2):499-512. doi:10.1016/j.jstrokecerebrovasdis.2018.10.033.
Post MWM, Zee CH van der, Hennink J, Schafrat CG, Visser-Meily JMA, Berlekom SB van. Validity of the Utrecht Scale for Evaluation of Rehabilitation-Participation. Disability and Rehabilitation. 2012;34(6):478-485. doi:10.3109/09638288.2011.608148.
van der Zee CH, Baars-Elsinga A, Visser-Meily JMA, Post MWM. Responsiveness of two participation measures in an outpatient rehabilitation setting. Scandinavian Journal of Occupational Therapy. 2013;20(3):201-208. doi:10.3109/11038128.2012.754491.
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